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                  您當前的位置:職稱驛站 > 論文 > 醫學論文 > 臨床醫學論文職稱驛站24小時論文發表咨詢熱線:400-680-0558

                  中級臨床醫師職稱論文白血病診斷中流式細胞術應用技術制度

                  職稱驛站所屬分類:臨床醫學論文發布時間:2016-11-20 13:55:43瀏覽:1

                  正確認識現在白血病的診斷以及治療的方式,同時要如何來對現在白血病的治療上有哪些新技術等等方式都是現在臨床醫學治療的主要研究方向。本文選自:《白血病·淋巴瘤》,《白血病·淋巴瘤》雜志是由中華醫學會主辦的中華醫學會系列雜志,是以白血病、淋巴瘤為主的血液系統惡性腫瘤學科的專業學術期刊。

                     正確認識現在白血病的診斷以及治療的方式,同時要如何來對現在白血病的治療上有哪些新技術等等方式都是現在臨床醫學治療的主要研究方向。本文選自:《白血病·淋巴瘤》,《白血病·淋巴瘤》雜志是由中華醫學會主辦的中華醫學會系列雜志,是以白血病、淋巴瘤為主的血液系統惡性腫瘤學科的專業學術期刊。

                  白血病淋巴癌雜志投稿論文

                    摘要:白血病借鑒了熒光顯微技術與血細胞計數原理,同時利用了熒光染料、激光技術、單抗技術以及計算機技術的發展,故其檢測結果具備了精確、客觀以及快速的優點[4],在很大程度上彌補了骨髓細胞形態學帶有較大主觀性和骨髓病理學檢查費時相對較長的缺點,從而為白血病的快速準確診斷提供了一個強有力的檢測手段,值得臨床大力推廣應用。

                    關鍵詞:白血病診斷,細胞術,臨床醫學論文

                    1 臨床病例

                    病例1,女,25歲,因“反復四肢關節腫痛三年余,伴全身淺表淋巴結腫大、腎功能損害3個月”于2008年9月28日來診,曾在外院診斷為“①慢性腎功能不全;②系統性紅斑狼瘡?”來診時疲倦乏力明顯,四肢關節輕度腫脹,疼痛有熱感,全身淺表淋巴結腫大,以頸部淋巴結明顯,血肌酐、尿素氮輕度升高,血常規示為WBC 6.39×109/L,HGB 65 g/L,PLT 194×109/L,并可見一定數量幼稚細胞。入院后即行骨髓穿刺及骨髓活檢術,作骨髓細胞形態學及病理學檢查,并以血常規管抽取靜脈血3 ml作流式細胞術分析。當日骨髓細胞形態學報告提示:淋巴瘤白血病。2 d后流式細胞檢查結果回復:幼稚細胞占61.8%,其表型為CD34+,CD117-,TDT+,CD79a+,CD33+,CD13+,HLA-DR+,CD19+,CD56-,CD38-,CD10-, CD14-,CD64-, CD2-,CD3-,CD5-,CD7-,結果符合前驅B急性淋巴細胞白血病/淋巴母細胞淋巴瘤。回顧臨床資料,該患者起病以來血小板計數一直正常,并主要以淋巴結腫大、四肢關節腫脹疼痛為表現,符合淋巴母細胞淋巴瘤外周血和骨髓的受累很少導致血小板減少,以及該病主要以淋巴結和骨及骨關節易受侵的特點。以相應方案化療后,患者病情較快緩解。骨髓病理檢查結果于送標本后第10日回復,亦證實為B淋巴母細胞淋巴瘤白血病。

                    病例2,男,40歲。因“肢倦乏力、牙齦出血腫痛伴發熱1個月”于2008年10月29日來診,曾在外院經骨髓細胞形態學檢查診斷為“急性髓性白血病-M5b”。來我院后即復查骨髓細胞形態學,并同時作骨髓活檢及抽取3 ml骨髓液作流式細胞術分析。觀察骨髓片發現其原始細胞雖然核型似M5,但胞漿顆粒相對增粗增多,不符合幼稚單核細胞特征,綜合考慮M2可能性較大。2 d后流式免疫分型結果回復:其髓母細胞占總細胞的36%,表型為CD34+,CD117+,CD13+,HLA-DR+,CD19+,CD56+,CD38+,CD64+,CD4+,CD2-,CD3-,CD5-,CD7-,結果符合急性髓性白血病-M2。數天后病理結果回復:符合急性非淋巴細胞白血病病理改變。以相應方案化療后,第20天復查骨髓示CR。

                    病例3,男,22歲。因“診斷為急性淋巴細胞白血病1年”于2008年12月24日來診。患者1年前因血紅蛋白降低、血小板減少在外院經骨髓細胞形態學檢查診斷為“急性淋巴細胞白血病”,其后在該院以急性淋巴細胞白血病化療方案先后化療8次,均未緩解,轉診我院擬行第9次化療。翻閱其病歷所記載化療方案,均為正規急性淋巴細胞白血病化療方案,且用藥正確得當,那么患者化療效果差的原因為何?是否白血病分型診斷有誤?入院后即復查骨髓,細胞形態學仍考慮為急性淋巴細胞白血病,同時取標本作流式細胞術分析,2 d后結果回復示:CD34+,CD117-,CD79a+,cMPO+,TDT+,HLA-DR+,CD19+,CD10-,CD33+,CD13+,CD2-,CD7-, CD20-, CD56-,CD38+, CD14-, CD64-,CD3-,CD5-,CD7-, CD15-,CD16-,結果符合急性雙表型白血病,即予NA方案(米托蒽醌聯合中劑量阿糖胞苷方案,對雙表型有效)化療,化療后半個月復查骨髓示原始細胞比例小于5%。

                    2 討論

                    白血病的診斷貴在快速、準確,以便臨床上能及時以相應方案對患者進行正確救治。從以上三個病例可以看出,流式細胞術在白血病的診斷和分型中具有重要的應用價值,其基本原理是利用熒光素標記的單克隆抗體作分子探針,多參數分析白血病細胞的細胞膜和細胞漿或細胞核的免疫表型,從而深入地了解白血病的異質性,準確判斷細胞的來源和所處的分化階段[3]。

                  《中級臨床醫師職稱論文白血病診斷中流式細胞術應用技術制度》
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